Arkansas
Safety Net Benefit Program

New Mexico
State Coverage Insurance

Oklahoma Employer/Employee Partnership for Insurance Coverage (O-EPIC): Premium Assistance &
Individual Plans

Federal waiver approved

HIFA, approved 2006.

HIFA, approved 2002.

HIFA, approved 2005.

Program Status

The state is currently reviewing proposals to select a private insurer to operate the program for the state.

Implemented July 1, 2005.

Implemented November 30, 2005.

Current or Potential Enrollment

By the end of the five year demonstration, the state expects to enroll around 50,000 workers with incomes below 200 percent of the federal poverty level (FPL) and another 30,000 whose incomes are higher.

As of June 2006, approximately 4,700 enrollees. The state expects 8,500 enrollees by the end of the second year and 40,000 enrollees within 5 years.

As of June 2006, 440 employers and 803 employees/spouses have enrolled. Program proposes to cover an additional 50,000 state residents with incomes at or below 185 percent FPL.

Eligibility: Individual

All working individuals who are currently uninsured and working for an employer who agrees to participate in the program. State will only provide a Medicaid subsidy for those with incomes under 200 percent FPL.

Low income, uninsured, working adults with family income below 200 percen t FPL.

Eligibility: Employer

Any employer with between 2 and 500 workers that has not offered an employee health plan for at least 12 contiguous months prior to electing to participate in the program is eligible. This is a change from original waiver request for 2-50 workers; however the state anticipates largely enrolling small firms because of the requirement that employers can not have offered coverage for 12 contiguous months. As a condition of participation, the employer must agree to ensure that all employees are covered, both above and below 200% FPL.

Must be small employer with <50 employees who has not voluntarily dropped a commercial health insurance in past 12 months.

Must be a small employer with 25 or fewer workers, contribute at least 25 percent of eligible employee's premium costs and offer an OEPIC qualified health plan.

Funding mechanism

Funded by combination of employer, employee, state, and federal funds.

Funded by employer and employee premiums, unspent federal SCHIP funds, and state funds.

Funded by employer and employee premiums, state general funds generated by a 2004 tobacco tax, and federal funds.

Employer premium

Employing actuarial analyses, to be determined by the carrier in concert with the state.

Employers pay $75 per employee per month.

Employers are required to pay 25 percent of the total cost of employee premiums.

Individual premium & cost sharing

Enrollees pay a $15 per month premium and 15 percent co-insurance with a maximum out-of-pocket cost of $1,000 per year.

Premiums and co-payments correspond to income grouping (1-100 percent FPL), (101-150 percent FPL) and (151-200 percent FPL). Employee pays from $0-$35 per month based on grouping. Individuals not with employers pay both employee and employer premium. Out of pocket payments must not exceed 5 percent of enrollee's family annual income.

Employee is required to contribute no more than the lesser of either 15 percent of their premium or 3 percent of their gross income. State pays for costs incurred above these amounts. Deductibles and co-pays vary with provider chosen by employer.

Crowd out provisions

Only employers that have not offered health insurance during the preceding 12 months may qualify for the program.

Prohibits eligibility if individual has voluntarily dropped insurance coverage within last 6 months. An employer who has voluntarily dropped commercial coverage in past 12 months is not eligible.

State permits employers to voluntarily drop previous coverage.

Benefits (if known)

The benefit plan will include six clinician visits, seven hospital days, two outpatient procedures/ER visits per year, and two prescriptions per month. No catastrophic coverage is provided under this program.

The benefit package is similar to a basic commercial plan-including primary and specialty care, inpatient and outpatient hospitalization, prescription drugs, lab, X-ray, physical, occupational, speech therapy, behavioral health and substance abuse services and includes a $100,000 annual benefit limit. Benefits not included in the NMSCI plan are: vision, dental, hearing aids, long term nursing services, pulmonary rehabilitation, non-emergency transportation and hospice care.

For both plans, benefits are dependent upon provider selected by employer group or individual enrollee. Please see www.oepic.ok.gov for description of plans.

Plan
involvement

Program is currently selecting participating plans through a competitive RFP process.

Medicaid managed care coverage provided by three participating health plans of which employers and individual enrollees have their choice. There are no differences in premium amounts or benefits, which must be consistent with those listed in the NMSCI program manual

Employers have choice of several health plans. For a complete list see website. Deductibles and co-pays vary according to the plan.

Application process

To be developed by the carrier in concert with the state.

Employers and Individuals apply for coverage through one of the participating managed care organizations. Applications may also be obtained via website

After selecting an OEPIC qualified health plan, employers may apply for worker coverage online. Individuals meeting eligibility requirements can also apply online.

Marketing and outreach strategies

Program website and media coverage. The carrier will be responsible for marketing and outreach.

Website, brochure distribution, media coverage, press conferences, engaging with tribal government and community organizations, brokers target employers.

Program website contains eligibility and application information.